Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
In Reply: Dr Levin-Scherz and Dr Yaes both
point to the important role of financial incentives in determining the rate
of spread of an innovation. In the framework of Everett Rogers, such incentives
alter the "perceived advantage" of an innovation compared with the status
quo.1 However, financial consequences are
only part of the story. If they were adequate, why would hospitals, for example,
not be rushing to use queuing theory to reduce delays in their own operating
rooms, or streamlining documentation to avoid wasting the time of their nurses
in useless recordkeeping, or standardizing treatment protocols to the best-known
models—all of which save money and improve quality at the same time?
The answer is that these require changes in behavior, attitudes, and systems
that attenuate responses to incentives, alone.
Berwick DM. Early Diagnosis of Sarcoidosis. JAMA. 2003;290(11):1454-1455. doi:10.1001/jama.290.11.1454-a